7/29 Max AMPS 386+2 479+4 490 +6 475

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Hi Lori!

I was reading your condo from yesterday - did the vet explain to shoot the Simbadol onto his gums for best absorption? With my kitty Pearl who has chronic pancreatitis, I don't even try to open her mouth, I just slide the syringe in at the corner of her lips and squirt it.

Buprenorphine can really hit some cats hard. What is his dosage? If you feel it's too much (he is too lethargic and out of it), you could always try squirting in 1/2 of the amount. My cat Whisper had a sensitivity to Bupe and it didn't work well for her, it affected her breathing (she is the black cat in my profile pic, Pearl is the Siamese).

I know you are doing the Cerenia (at least I think I remember rightly), so bravo that is another big piece of managing pancreatitis. Sub q too. Even when Pearl is not flaring, I do the sub q 1-2 times weekly to help with her hydration (but I know you have to be careful about that with the murmur - the cardio appointment should be able to confirm for you if/how much fluids you can give regularly). She tends to have very hard bowel movements also without it.

Also, when Pearl is having a Panc flare, her BG increases. Marje helped me understand when first diagnosed with FD that I need to increase the dose when needed (even if I suspect it's in the middle of a pancreatitis flare and the pancreatitis is the cause of the extra-high BGs). That could really be affecting your boy, and I hope as he starts to feel better you will see it in his BG readings, too.

I also want to add - Pearl is also an asthmatic. You can definitely manage asthma and FD together. Inhaled steroids really should not affect the BGs. They go directly to the lungs and target only the lungs. Steroids that affect BGs are oral, most common Prednisolone. Have you tried the inhaler steroids? Asthma attacks also increase and keep BGs elevated, I have found with Pearl after she has an attack or is struggling more with her breathing, it's definitely reflected in her BG.

Hang in there! Seems like Max and Pearl have some things in common!! Hugs from Pearl to Max!
 
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@Margaret (and Pearl) Wow it sounds like they do have a lot in common! Yes the vet explained all of that about the bupe. I think he’s just super sensitive to it. It made him absolutely crazy and it’s just now wearing off some. He seems more like my sweet cat now. I may try half the dose on the syringes he gave me. The vet gave him the injection which he said was twice as strong as what he sent me home with. Yes Max does have a Fluticasone inhaler. His flares are usually when the weather starts to turn colder so hopefully we can get his diabetes under better control by then. He doesn’t use any systemic steroids unless his asthma is severe. What does your cat use for pain? Hugs to Pearl from Max!
 
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Max & Lori said:
Wow it sounds like they do have a lot in common! Yes the vet explained all of that about the bupe. I think he’s just super sensitive to it. It made him absolutely crazy and it’s just now wearing off some. He seems more like my sweet cat now. I may try half the dose on the syringes he gave me. The vet gave him the injection which he said was twice as strong as what he sent me home with. Yes Max does have a Fluticasone inhaler. His flares are usually when the weather starts to turn colder so hopefully we can get his diabetes under better control by then. He doesn’t use any systemic steroids unless his asthma is severe. Hugs to Pearl from Max!
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I like the 1/2 syringe of Bupe idea. I have had 2 cats super sensitive to the injection. And best part about 1/2 syringe you can always increase to the full if it looks like he needs it!

have you ever considered inhaler year round? We do that, after having some harrowing experiences that were tough to pull Pearl back from and at a time of year I did NOT expect it. I love that the consistent use keeps her lungs calm and easy. Idk if underlying asthma inflammation could be contributing to Max’s BGs but it is possible. Might be worth an inhaler experiment at some point down the road.

hope you start seeing some encouraging numbers soon on the new dose!
 
Max & Lori said:
Max still not feeling well today. For one thing the Simbadol has not worn off and he is still not resting because of possible side effects from that. He is eating well but otherwise does not act like himself. I’m thinking about going ahead and increasing his Lantus to 6u tonight. Yesterday’s https://www.felinediabetes.com/FDMB/posts/2826895/
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I definitely agree with the dose increase. And I also am a proponent of going with half doses on the bupe an increasing as necessary.

When my kitten was spayed, they gave her way too much and she went from one water bowl to the next, digging in them & throwing water everywhere. She looked like a seal! And she was wide awake. I didn’t give her another dose for 24 hours & then gave her a 1/3 dose which worked well.

Good luck with the increase.
 
Hi Lori. I've been reading up on Max. You've really been hit hard since June 24 when Max was diagnosed. My kitty went DKA too (last fall) and was in the ER and the regular vet for a week. He had an Esophageal feeding tube placed and we did use it for a while, but he started to bounce back and eat on his own. I see that Max has been eating so that's FANTASTIC.... a very good sign. I was just checking in to see how Max is doing today. I'm glad he's back on Lantus and that you've been ramping his dose back up pretty quickly. We had pretty good luck with Lantus and even better with Levemir. Darcy was never responsive at all to Vetsulin (lasted only a few hours) or even ProZinc (but we also had not reached a high enough dose for him on ProZinc).

Since Max's numbers are so high and he's already been DKA, are you testing his blood (or urine) for ketones? I started after Darcy went DKA. I bought the Nova Max blood ketone meter from ADW Diabetes Supply. The strips are expensive :-( about $1.80 each, but I would test once a day for a while...until his numbers came down into more reasonable territory.... then every other day, etc. I wasn't able to "stalk" Darcy to the litter box as our house is too big, I have too many cats, and too many litter boxes. I also liked that ketones will show up in the blood before they show up in the urine. The ketone meter also gave me a definite number and I liked that accuracy, instead of just a color on a strip with a range of numbers associated with that color like the urine strips do.

As for the Buprenorphine, your instincts are good. There is a great deal of variability in cats and their responses to Bupe. Some are more sensitive to it than others. I think your instincts are good on that to try the reduced dose. Are you giving him fluids at home for the pancreatitis? Or Cerenia, which is really helpful with pancreatitis? You certainly have your hands full right now! Max is a very handsome orange kitty! I have one of those sitting in my lap right now bathing himself (Oliver). All my best thoughts and prayers to you and Max!
 
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